Forum:(Policy) Clearly distinguishing medic scope of practice on this wiki
With his permission, I am posting an email exchange between another site editor and me. This is a great start to a conversation about a policy representing how we will clearly distinguish the scope of practice on this wiki. Street medics in some regions are more community-oriented or protest-oriented. Different regions have have different options about patient safety and access to advanced care. But as a website serving as a resource to any region, how do we avoid confusing new medics and leading to harmful situations? Gobblehook 00:29, 10 December 2006 (UTC) Audience / Emphasis on scope of practice 1) it is difficult even for trained personnell to detect MI and CVA in the field, especially if they are not exposed to them regularly, mainly due to the vaired symptomology and presentation of both. Even "classic" signs can be misleading. 2) Anything that involves administering or assisting with any sort of medication takes technically takes medics out of thr realm of good samaritan and exposes them to legal libility issues. - Damn rob I am posting the articles mostly as a resource for street medic researchers, trainers, and for the same continuing ed function that the a-m list and the UK medics list serve. I am doing work with a few other editors (a circle I hope will expand) to bring training handouts up to date. In the pre-release, all protocol sheets include the following "Note": :"This material is intended as a training supplement. Reading this material is no substitute for first aid / medical training with a qualified trainer. We encourage you to pursue ongoing education, reviewing and upgrading your skills-- for the safety of both yourself and anyone you treat." Maybe you could suggest ways to better stress this point, for both liability and safety reasons. My hope is that the wiki will become a resource to the medic community in a similar way that the list serve is: pretty damn public, but moderated, and frequented almost entirely by medics with only a few degrees of separation. - Gobblehook I think basic recognition skills are important. I am personally not in favor posting anything (about first aid for AMI) suggests administering or helping administer medications, especially ASA or NTG. *ASA is a blood thinner that will aggrivate ulcers and make bleeding more difficult to control if AMI is misdiagnosed and other bleeding is an issue. Additionally people frequently have ASA allergies. Even if they "always take it" Administering, without proper training, is not something I would suggest. *NTG is a vasodialator that releaves AMI symptoms by allowing blood to flow more freely through the hearts veains and arteries. However part of its actions include a dramatic sometimes unpredictable drop in Blood pressure. Given without proper training NTG can cause more harm than good. Just my 2 cents on that. - Damn rob We didn't inclusde MOFIBA in a recent training here in New Orleans because they mostly only use chem weapons in OPP (the parish prison), where you can't necessarily get the decontam stuff. Even in there, they're more likely to use restraint and segregation, starvation, beatings, stun belts, or tasers. However, we taught a lot of things that we didn't have hand-outs (yet) for that are really relevant to us: CO poisoning, basic AMI/CVA, basic OD, we talked about MRSA, and we should have taught basic small infection care. That stuff matters because of the age and health problems of as lot of the people we expected our medics to see, the lack of qualified care in the city, the MRSA epidemic, and the number of our medics who are running generators, living in trailors, or gutting damaged houses. - Gobblehook One other thing i would like to mention. In the training CO, OD, MSRA, MI/CVA falls WAY out of the scope of what a "street medic" is capable of dealing with. While I am glad to hear these things being taught I dont think that they should be taught under the "street medic" trainings. What has happened in NO post-katrina is amazing in terms of our response, yet I feel that it has taken us from the realm of street medicing for protests, to community health. While this is great, it also comes with responsibility. Street medics, at the most basic level, have a 30 hour training and then can theoretically run in the streets. This is fine, as, at least in my trainings, it is stressed that if they dont know what to do they should call someone who does or call 911. As practitioners of community based health, I feel there is a lot more responsibility palced on us to be knowledgable about a wider range of things. Again, while these trainings seem to do that, and I can definately help write care sheets and "how to stay safe while..." sheets, i do not think that they fall under the scope of street medicine. I would definately feel more comfortable with a creation of a second page, aside from but likned to thet street medic wiki, that included this information under a different title. But thats just my two cents. - Damn rob Wikis as a way to pass on medical knowledge I am personally not comfortable with wiki as a way to pass on medical knowledge. I love technology as a teaching aide, and i love the democratic aspect of the open posting of wiki, however when dealing with medical training, i think both of wiki's strengths become weaknesses. For one, I am a firm believer that you can not learn medicine/protocols by reading hem alone, but rather that you need actual training to learn effectively. Take for example all of the "textbook" medics in EMS who can recite anything from a book but are clusless when it comes to actual patient contact. Additionally, the fact that anyone can post to wiki means that anyone can intentionally (as in undercovers etc) or unintentionally (as in well intentioned people who dont really know what they are talking about) post information that is incorrect, and it is very hard to notice and correct these mistakes (unless they are glaring) without making the whole article confusing. Additionally, there was no way that I saw to know who posted what, meaning that there is no accountability. To me these are not condusive to medical training - Damn rob About trustworthiness of editors: *On the Medic Wikia, the words "currently editing" in the phrase "We are currently editing over 75 articles..." is a link to all of the most recent changes on the page, including the editors username or IP address. I moderate it, and will invite other active editors I can confirm are trustworthy medics to moderate it too. I will focus on developing a diverse group of editors and a representative group of moderators. Moderators can lock frequently vandalized pages, and can ban certain names or IP addresses. About first aid info on the net: *There is plenty already. I have mirrored mostly content from caches of the now-dead action-medical.net, from Black Cross, from BALM Squad, from MANY and STORM*NYC, and from the list serve. I have also added my favorite set of basic training handouts to largely replace Brian's, which were posted on a-m.net. I ask the editors to justify any change to published or accepted medic protocols in any article, on the article's talk page. - Gobblehook what you are doing sounds great. As long as balance is kept so that it can be democratic but still accountable. This is something that is tough to do in the medic community period. Everything I write and put out as info is peer reviewed. - Damn rob Regional differences in protocols I think it is important to acknowledge regional differences in protocols. In New Orleans, we do things different than Boston, who do things different from y'all, who do things different from MASHH outwest, right? So, I would like to try to develop a policy that encourages the infosheets to include potentially controversial (region-to-regionally) material with protections. These could include warnings, and segragating the info on the same page, or linking to it on a different page, as Black Cross did with their chemical weapons protocols.(See Pepper spray and tear gas.) It could also include multiple infosheets on the same protocol, grouped regionally. The way I see it might play out in trainings is like we did here. We used Brian Dominick's chemical weapons training handouts, but just whited out all the MOFIBA related info. I think trainers should use discretion. However, I think no really controversial or potentially dangerous stuff should go without a warning. I hear you on that. - Gobblehook 00:29, 10 December 2006 (UTC) Agreed that different regions do have different protocols. However i am personally not a big fan of that fact. In my perfect little street medic world care would be standardized (more or less) by different trainers getting together and discussing different ways to treat things and decideng what is the most effective, not which one they like the best, and including that in trainings. As it is most differences I have seen come from preferences and not from differences in effectiveness. I mean, for example tear gas is tear gas, it acts the same on the west coast as it does on the east coast, treatment, in my eyes, should also be the same to avoid confusion. That being said, I am no stranger to controversial things when it comes to street medicine. what i will do is write up everything as I have it and post. If others have problems with what is up there they can start that discussion on the thread. I will do the same as I notice things I dont agree with in others posts. - Damn rob Permission to post This discussion would be really useful to people who work on policies for the wiki, but I think we'll probably only have it once. The wiki is a big change for the medics, and will carry all the risks and hidden possibilities of one. It may be a bad idea in the end. I would like to repost your edited comments to a forum page and reply there in a few days. It will make it much easier to refer to during the ongoing collaboration - Gobblehook yeah move whatever you think will be more productive there...no problems - Damn rob Here is other people having a similar conversation: http://meta.wikimedia.org/wiki/Medical_dictionary_wiki - Gobblehook 10:51, 10 December 2006 (UTC)